Laserfiche WebLink
ruin a <br />OFFICE OF THE CONTROLLER AND <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM roes <br />Date t' z z o y Department L_ <br />BPW Date `�p Phone S' r b � <br />Name <br />o Legal Attorney Name: GOO,4)/-IL <br />vO b Controller review. is required for all Contracts $5,000.00 or more and greater than one <br />o Controller ❑ year in length per the City Purchasing Policy <br />o <br />Cr a qa Other <br />94 Appropriate ❑ Other, as appropriate: <br />N Reviewers <br />Type of Item ❑ Contract/Agreement ❑ Proposal ❑ Addendum ❑ Claim <br />Pq.Easement/Encroachment ❑ Resolution ❑ Traffic Control Device <br />VF <br />_ ❑Other: -- ------------------------------------ <br />- - -------------------------- - <br />Company or Vendor Name ,�/ O alVn / 1Gtit-e �'v c2 <br />Project Name ©- <br />�'o o Project Number (Engineering) /� <br />o Amount $ Funding Source <br />Purpose/Description: <br />U Terms of Contract: <br />�c <br />Type of Item ❑ Advertise ❑ Bid Opening❑ Bid Award ❑ Quote Opening ❑ Quote Award <br />Cn ❑ Title Sheet ❑ Other <br />-------------------- - - - - -- ------------------------- <br />Company Name <br />Project Name <br />p" Project Number (Engineering) <br />Contract[Project Amount $ Funding Source <br />Type of Item ❑ Chg Order ❑ CIO & PCA ❑ PCA ❑Other: <br />---------------------------------- <br />--------------------------------- <br />u Contractor/Consultant Name <br />Project Name <br />O Project Number (Engineering) PO Number <br />W Amount of ❑increase ❑Decrease $ Current Percent of Change: % <br />Original Contract/Project Amount $ Total Percent of Change: °/a <br />U New Contract/Project Amount $ <br />Purpose/Description: <br />Col <br />;> ❑ <br />�n n <br />nal <br />List Name, Dept., Address (if appropriate) of who should receive document <br />( C 0 1 _090 1(__*PL___000 V <br />